The Enhanced Doctor-Chapter 678 Night Terror Syndrome

"Baozi, what’s wrong with you?"

As Ma Limin came over, she noticed that something seemed to be off with Wang Chao.

"He’s gearing up for great responsibilities. In a way, his status is about to undergo some changes, so he’s a little excited," Liu Banxia explained.

"Oh? I hadn’t noticed. Does our Baozi have his moment in the spotlight? Is he going to be promoted?" Ma Limin became even more curious.

"We’re not talking about a promotion, but he’ll be in charge of a significant project. In a few days, he’ll also take over the chief resident’s duties. By next year, he’ll be an attending physician in our hospital," Liu Banxia added.

Ma Limin blinked a few times, giving them a somewhat skeptical look.

She felt something was out of place. This should be good news, so why did Baozi look as if he were constipated?

"Okay, you two chat. I’m going to step aside and get some work done," Liu Banxia said, then added before walking away, "Chao, keep an eye on the time. You’ll need to meet the director with Brother Hui later."

"Baozi, you didn’t get into trouble, did you?" Ma Limin asked.

"No, do you think I dare cause trouble? I’ve always lived carefully," Wang Chao quickly responded.

"Then why do you seem so shifty? You look like you’ve done something you don’t want anyone to know about. Don’t forget, I’m a police officer. No wrongdoer can escape my eyes," Ma Limin said seriously.

"I really didn’t. Didn’t you hear President Liu? I’m going to be in charge of a project. This isn’t a joke. Are you here to see Dazhuang? His recovery has been excellent these past two days," Wang Chao said.

"Don’t talk nonsense. He’s my master. How can you address him so casually? I’m leaving. You can stay here and reflect on your actions." After saying this, Ma Limin headed directly towards the ward upstairs.

Wang Chao let out a long sigh, feeling even more conflicted. Was I fooled by that guy Liu Banxia? With how well we know each other, can this really work?

While Wang Chao was still pondering, Liu Banxia sneaked up and whispered, "You need to put in some effort," then slipped away again.

Wang Chao glared at him resentfully. What a terrible friend to have made! Judging by the looks from the interns, that guy was probably already spreading rumors.

Forget it. I should stop thinking about this and prepare to explain the project to the director. This is indeed a significant event in my life and can be considered a milestone.

Liu Banxia wasn’t idle either, as there had been quite a few patients yesterday. Even if he didn’t have to do rounds, he still needed to review these cases.

So far, his role as chief resident had been quite stress-free, largely thanks to the capable surgical team from the emergency center. Everyone could complete their tasks promptly and shoulder their responsibilities.

Otherwise, he wouldn’t be able to sleep so soundly. He’d be constantly on the move, with no leisure time at all.

"Banxia, cover for me. The director should be free now."

Xu Hui, who was still reviewing patient cases, came over.

"Okay, go ahead. Approved in three days, built in half a month," Liu Banxia replied with a smile.

"I’ll take your good wishes then. I’m off," Xu Hui said.

Liu Banxia stretched lazily. Good, there were no patients waiting in Internal Medicine. Xu Hui must have taken care of everything before coming to get me.

Just five minutes after he sat down, a couple came in with a boy in his early teens. The boy seemed extremely lethargic, as though he hadn’t slept for days, continuously yawning.

"Are you Dr. Liu Banxia?" the child’s father asked.

Liu Banxia was taken aback, nodding. "Yes, I am Liu Banxia. Do you know me?"

"I’ve heard your name. You cured Wang Xiaobo from our village of his insomnia. My son also can’t sleep," the child’s father hurriedly said.

"Alright, please sit down first. I’ll take a look at the situation," Liu Banxia nodded.

He remembered this patient, Bo. He was the one who always had nightmares when he slept; it turned out he actually had a testicular teratoma.

The young patient was fourteen years old. His symptoms were an inability to sleep at night and waking up abruptly. This had been going on for about half a month, progressing from once or twice a night at first to about ten times a night now. The boy essentially couldn’t get a full night’s sleep.

"Has he suffered any head injuries? Are there any other symptoms? Has he had any other illnesses?" Liu Banxia asked.

"About half a month ago, while playing soccer with his classmates, he bumped his head when going for a header. But nothing seemed wrong at the time. It wasn’t until the second or third day that we noticed he seemed a bit listless," the father explained.

"A few days later, we heard from his school teacher. He was apparently zoning out in class, not listening, and couldn’t answer any questions. Only then did we realize he was often jolting awake in his sleep."

"We were too careless. We’ve been too busy with our daily lives and haven’t paid enough attention to him. We had him checked out at a hospital in our county. Here are the films from the examination; they said nothing was wrong."

"Later, when Bo found out about this, he told us to come here and find you, saying you’d definitely be able to figure out what’s wrong. Our child isn’t doing well now. He can’t sleep or eat properly, and he has no energy at all."

Liu Banxia nodded. "I can look at the films first, but they will only be for reference. If necessary, we might still need to conduct more specialized examinations."

"However, registering with me isn’t quite right. Normally, you should see a neurologist. I’ll have a look first, and if it’s necessary, I’ll call a neurologist over."

"Thank you, Dr. Liu, thank you," the father replied quickly, handing him a bag.

Liu Banxia glanced briefly at the other test reports. They were done too long ago to be of much help. He was more focused on the cranial CT scan, which was taken eight days ago.

However, the cranial CT scan did not reveal any visible issues.

"Did you feel uncomfortable anywhere after hitting your head?" Liu Banxia asked the child after putting down the films.

The child shook his head. "It just hurt a bit, then nothing. I just twitch in my sleep sometimes. That’s happened before."

"But afterwards, the twitching got more frequent—either flailing my arms or kicking my legs. It’s that kind of sudden waking, and then I can’t get back to sleep for a long time. Now, it seems like as soon as I fall asleep, I wake up."

"And what about your coordination? For example, do you feel uncoordinated? During PE class activities, are there any movements you find you can’t do?" Liu Banxia continued to ask.

The child thought for a bit and shook his head. "I haven’t really been to PE class lately. I’m really sleepy during the day. When I sleep during the day, I also wake up suddenly like that. Once, I even shouted out in class."

Liu Banxia nodded, his mind racing.

From the child’s current presentation, it looked like symptoms of night terrors, but the possibility of an organic brain lesion couldn’t be ruled out either. Moreover, the child had hit his head, and these symptoms only appeared after that incident. As for the child’s lethargy, that was also understandable; anyone who hasn’t had a proper night’s sleep for so long wouldn’t be energetic.

"Let’s do this: I still recommend a cranial CT scan to check for any organic brain lesions," Liu Banxia said after some consideration.

"Although the CT scan you have doesn’t show any signs of edema or hematoma, and it’s been a while, we still need to prioritize ruling out delayed hemorrhage."

"Another possibility is that the child’s head injury resulted in a concussion. It often manifests as insomnia, dizziness, headaches, nausea, tinnitus, difficulty concentrating, slow reactions, night terrors, and so on."

"It’s similar to when some children witness horrifying scenes. They often have nightmares and can scare themselves awake. This is also a type of traumatic stress response."

"Dr. Liu, he does have slow reactions and difficulty concentrating, but he doesn’t have the other symptoms you mentioned. Is it really a concussion?" the child’s father asked.

"For now, these are my two suspected possibilities. If the CT result is negative, then I’d lean towards it being a concussion," Liu Banxia said.

"The treatment for a concussion is actually quite simple; no medication is usually needed. The brain has a self-repair process. Also, the effects of a concussion often disappear after about two weeks."

"So now there are two choices: either go home and continue to observe, or do a cranial CT scan to see if there’s any organic brain lesion."

"Let’s do the scan. Please take a good look. Even if it’s a concussion, I want him hospitalized. Bo said his problem started while he was sleeping, and then you figured it out," the child’s father said decisively without hesitation.

"In that case, go get a CT scan first. We’ll discuss it further after the images are out," Liu Banxia nodded.

In his heart, he leaned more towards a concussion, but chronic delayed hemorrhage also had to be considered. Even if the probability was low, it didn’t mean it was impossible.

Rural areas aren’t like big cities. In a big city, if a child hits their head, there’s a good chance they’d get a cranial CT scan immediately, and a concussion might be diagnosed right away. In rural areas, bumps and bruises are common. Unless it was a major cut with a lot of bleeding, people generally wouldn’t go to the hospital.

Perhaps it’s due to the brain’s miraculous nature, but concussions can manifest in diverse ways; some people even experience retrograde amnesia. Moreover, concussions are difficult to detect with imaging. Even with an EEG, the results are usually negative. Available interventions include sedatives, medication to improve autonomic nervous system function, psychological counseling, reducing external stimuli, and so on. However, these didn’t seem necessary for this child. The prognosis for concussions is generally very good; it’s just that the acute phase can be quite difficult to endure.

However, a big question mark remained in his mind. After all, the child didn’t have headaches or dizziness, which contradicted the typical presentation of a concussion. If it weren’t for this, he wouldn’t have even ordered a CT scan.